RCM Automation for AI-Powered Eligibility Verification and Authorization Management
AlphaVerify leverages intelligent automation to support human services and post-acute organizations with verifying eligibility, securing authorizations, and validating the coordination of benefits.1
Infuse intelligence early in the revenue cycle to support RCM accuracy and denial prevention
Driving accuracy in benefits coordination is critical because it determines whether an encounter is set up for reimbursement or set up for rework. Small errors in eligibility verification, prior authorization management and coordination of benefits at intake can quickly cascade into denials, delays and strained collections efforts downstream. That’s why many organizations across behavioral health, addiction treatment, child and family services, home healthcare, hospice care and more are turning to RCM automation to strengthen this front-end discipline.
AI eligibility verification runs near real-time coverage checks that, when paired with rules-based workflows and intelligent data capture, can help reduce variability and human error. The impact extends far beyond intake: when benefits coordination is accurate from the start, intended outcomes are clean claims moving faster, authorization gaps being minimized and billing teams spending less time correcting preventable issues. In this way, AI (augmented intelligence) transforms benefits coordination from a manual front-end task into a strategic driver of downstream revenue performance, supporting revenue cycle efficiency, predictability and overall strong outcomes across the revenue cycle.
Targeted benefits of automation at the beginning of the revenue cycle
Improvements
In Revenue Capture
Reduced
Denials
Smarter AI-Enabled
Workflows
AlphaVerify at a Glance
Automated Eligibility Verification and Benefits Discovery: Targeted Benefits
- Know patient coverage status in seconds, not hours while accelerating admissions and reducing manual portal lookups
- Eliminate manual data entry errors and drive accurate benefits coordination
- Prevent denials due to inactive insurance and catch issues before services start
- Facilitate accurate primary/secondary billing from the start and maximize reimbursement
Automated Prior Authorization Management: Targeted Benefits
- Identify authorization requirements instantly with automated alerts based on real payer policies
- Maintain visibility into every authorization through automated tracking of submission status, expirations, and approval or denial outcomes
- Avoid coverage gaps and care delays with proactive alerts that notify you when authorizations are approaching expiration
- Accelerate admissions and approvals with auto-filled prior authorization forms
Workflow Automation and Team Management: Targeted Benefits
- Coordinators work the right accounts first, and in doing so, reduce delays and maximize throughput
- Match complex cases to experienced staff and help improve first-pass resolution rates
- Workload balancing distributes accounts evenly across the team and aims to prevent overload on individual coordinators
- Avoid burnout and support consistent service levels
Advanced Reporting and Analytics: Targeted Benefits
- Identify top performers and coaching opportunities with data-driven performance management
- Fix systemic issues, not just symptoms and work toward preventing denials at the source
Ready to take the next step toward denial prevention?
Connect with an RCM professionalWhat Could Your Team Achieve with a Revenue Cycle AI Assistant?
Benny is the AI-powered automation assistant within AlphaVerify, part of the Netsmart RCM automation suite. You may have heard of Benny from some of our other revenue cycle automation tools, such as AlphaCollector, where he serves as a digital collector, or AlphaCoding1, where he will offer insights as a coding assistant. Inside of AlphaVerify, Benny will function as a benefits coordinator, helping automate certain routine tasks so your human staff can focus on complex cases.
With the help of Benny the Benefits Coordinator, you can focus on:
- Catching issues early when they're easier to fix and getting one step closer to the goal of eliminating last-minute scrambles
- Guiding coordinators through complex workflows and tackling decision fatigue and errors
- Identifying trends and issues related to eligibility and authorizations to support stronger first-pass payment
"Our AI and automation solutions are built to drive the right workflow at the right time for the right team, helping providers achieve real financial results while staying focused on care."
- Erica Gregory, Senior Vice President and General Manager of Revenue Cycle ManagementRead the insights from our RCM experts
AlphaVerify FAQs
AlphaVerify will be a benefits coordination module within the Alpha suite, a set of RCM automation tools provided by Netsmart. AlphaVerify is designed specifically for human services and post-acute providers. The healthcare benefits coordination software combines intelligent automation, payer-specific rules and team management. Intelligent automation within the software supports organizations with verifying eligibility, securing authorizations and validating the coordination of benefits prior to and during care, with the intent to help reduce avoidable denials and improve efficiency in these administrative functions.
AI eligibility verification within AlpahVerify will run near real-time coverage checks, with the goal of teams being able to confirm patient benefits in seconds instead of hours. The intent is to catch inactive or changed coverage before services start or during services, which can help prevent denials.
Benny is the AI-powered automation assistant within the Alpha suite, which is a suite of AI RCM tools provided by Netsmart. Each revenue cycle technology offering within the Alpha suite has its own set of Benny assistants.
For example, inside of AlphaCollector, our collection automation technology that targets accounts receivables labor, Benny the Digital Collections Assistant guides collectors through denial resolution based on suggested best practices. Benny the Digital Collections Assistant interacts with 835 CARC codes and has experience guiding collectors through step-by-step processes for common CARC code groupings.
Additionally, Benny will serve as an ICD-10 coding assistant within AlphaCoding, our AI-Assisted Medical Coding tool.
Benny the Benefits Coordinator will live within AlphaVerify and function like a benefits coordinator, helping automate certain routine tasks so your human staff can focus on complex cases.
No, you do not have to have a Netsmart electronic health record to use our healthcare benefits coordination software. AlphaVerify is designed to integrate with a range of EHRs and clearinghouses.
Revenue cycle management automation applies rules-based workflows and augmented intelligence to front-end revenue cycle tasks like eligibility, authorization and coordination of benefits. RCM automation also applies rules-based workflows and augmented intelligence to back-end revenue cycle tasks like collections and denials management.
Revenue cycle automation software can help you protect revenue now and prepare for accelerated Medicaid churn. By running frequent, rules-based eligibility and authorization checks, coverage changes can be caught earlier. Human services and post-acute organizations can work toward reducing revenue instability by leveraging intelligent automation.
Revenue cycle automation can also help reduce avoidable denials. By surfacing missing or inconsistent data, coverage changes, missing payers and authorization issues earlier in the revenue cycle, human services and post-acute care organizations can work toward improved first-pass accuracy. This is important because common denial drivers include missing/inaccurate data and authorization issues (percentages vary by organization and payer).
Detecting secondary and tertiary payers, surfacing hidden funding sources and identifying self-pay liabilities earlier can support improved revenue capture. Revenue cycle technology can help recommend coordination of benefits (COB) sequencing based on available information.
Key anticipated users:
- AlphaVerify: Benefits coordinators, authorization specialists and front-office revenue cycle management teams.
- AlphaCollector: AR teams, collectors and billing managers working across their organization to resolve AR follow up requirements and/or AR projects.
- AlphaCoding: McBee (part of Netsmart) coders delivering coding services on behalf of home health and hospice organizations.
Anticipated workflows/benefits:
- AlphaVerify: Focuses on benefits coordination workflows. AlphaVerify is intended to help reduce denials and costly rework by improving pre-service eligibility, authorization processes and coordination of benefits (COB) requirements.
- AlphaCollector: Focuses on collections workflows (post-service). AlphaCollector is designed to help improve payment recovery after service. AlphaCollector also has an unbilled workflow.
- AlphaCoding: Focuses on ICD-10 coding suggestions. AlphaCoding retrieves and reviews patient clinical documentation from home health and hospice electronic health records (EHRs) and generates recommended ICD-10 diagnosis codes for coding the patient chart. AlphaCoding leverages augmented intelligence to review documentation and suggests codes guided by CMS coding guidelines.
1Solution currently under development and testing with early adopters. Netsmart makes no guarantees when, or if, solution will be generally available.